Pharmacy Winter II

I realize it is the end of March. They say March comes in like a lion and goes out like a lamb. I don't know who "they" are, but this is not true of "Pharmacy Winter". Last fall I wrote about the two seasons of Pharmacy. I mentioned that Pharmacy Winter lasts about 8 months, from the end of August when school starts, through Easter. There is a tapering of business from Easter until Memorial Day, but we can generally expect business to drop after Hop-Along Cassidy visits.

The other problem we face over the next few weeks is the planning procrastinator. He is the one who knew his insurance would be changing at the first of the year and had the foresight to get 90 day supplies on all of his maintenance medications. The only problem is he delayed bringing us his new insurance until this week...when his refills are due. Which also happens to be the same time all the people with new insurance are due for the refills on their 90 day supplies they received in January.
This means that Normal Spring truly heralds the last sputtering gasps of Pharmacy Winter. It is the final seconds of a college basketball game. Word of advice to all pharmacy patrons: Avoid the Pharmacy. Seriously. Call in your refills days in advance, sneak in at 10am or 7pm and hastily make your way to the exits.

Drug Names and Movies

Some drug names are rather neat, pleasant-sounding bon mots that roll off the tongue. Others are less eloquent than tongue-tying. Many a tongue has been injured whilst twisting itself around a few names.
When I train new technicians and it comes to drug names, I explain the difference between brand and generic like this: If you can pronounce it, it is Brand. If you cannot, it is Generic.

Hydrodiuril=Hydrochlorothiazide
Flomax=Tamsulosin
Singulair= Montelukast
Sinemet=Carbidopa/Levodopa (but it's really fun to say)


Anyway, the reason I gathered you all here today is for this week's Phriday Phun Day. If you were to write a movie, what drug name, brand or generic, would you use for either the title or main character?

I claim Montelukast. It can either be a hero or title as in The Count of Monte Lukast.
Or Montelukast's Revenge.

Rejected

Rejected Marketing Ideas or Drugs for Children:

Yo Gabba GabbaPentin
Cialis in Wonderland
The Today Sponge-Bob Squarepants
TussioneX-Men
BlackAdderall
Monty Python and the Holy Gralise
Magic Mouthwash Mike (ew)
The Exor-Cystex
CanasaBlanca
Star Treximet

A New Alphabet

Tired of the whole "Alpha, Bravo" or "N as in Nancy" conversations when speaking with insurances? Want to liven up the entire process? Want to test the mental mettle of those with whom you are speaking? Try this approach:

Letter: As in ________

A: Canadian question, Eh? 

B: Honey

C: Ocean

D: She wants the...

E: MC2

F: Not Passing

G: 'Sup

H: To the Izz-O

I: Me

J: Walker

K: Potassium

L: Train

M: Bond's Boss

N: Enema

O: I See

P: Urine

Q: Line

R: Pirate

S: Psycho

T: Fore! (or Lipton)

U: Not Me

V: To the Izz-A

W: Tungsten (or Bush?)

X: Former

Y: Who's Asking?

Z: Czar

Wheel of Excuses--Prescriber Version

For some #PharmacyPhun, I am going to design a gameshow type wheel for use in our store before phoning prescribers. We will have it mounted on the wall near the pharmacist phone. Whenever we have to call an office or hospital for clarification on any matter, we will all place bets on which line(s) the office will use on us. Bonus points are given if you guess multiple answers in the correct order, like hitting the trifecta.

1. That's what it says.
2. She always writes it that way.
3. You're the only pharmacy that calls about this.
4. (Office reads the e-script back to you.)
5. They're not in this office today and I'm not allowed to give you the number to where they are today.
6. We've been using stamped signatures forever. It's just _________. (pick one: amoxicillin, penicillin, any bowel prep, toothpaste)
7. He wants what the patient had last time.
8. Don't you have in your system what he always gets?
9. I'll ask but she's not going to change it.

Drug Prices and Manufacturers

In the beginning there was naproxen, and it was good. Along came stomach pain and Esomeprazole was created. (Forgive the timeline breaks. I'm trying to speed up the story.) And it was good. Along came profits and Big Pharma wanted more. And on the seventh day, Vimovo was created. And pharmacists and insurances said #GTFO!

By the Numbers:                         Acquisition Cost (AC)

Naproxen 500mg tablets #100    AC $7.56   

Esomeprazole 20mg caps #30    AC $29.97  

Vimovo 500/20 #60 ct bottle      AC $1409.54      

Will someone please explain to me how this pricing is possible? This would be the same as spending $5.00 on a large jar of Jif Peanut Butter, $4.00 on a large bottle of Strawberry Jelly, and $2.00 on a loaf of bread then charging $200.00 for a single PB&J sandwich. 

I counseled a patient whose insurance, for obvious reasons, did not want to pay for Vimovo. I explained my costs and that she could purchase the "ingredients" individually over the counter and make her own. If she could get her prescriber to write for each of them, she could get her insurance to pay for them. A week after our conversation, the patient returned. We again tried to fill the Vimovo, as the prescriber had assured her they had attempted a prior authorization, only to discover it was not approved. The Sweet Little Patient then told me about her conversation with her prescriber. 

CP: Did you ask her about changing it to its individual components? 

SLS: Yes. 

CP: How did that go? 

SLS: She said "I don't want you to take it that way."

CP: Your doctor said that? 

SLS: Well, she's a nurse practitioner. 

CP: Ah. No excuse for stupidity. Did you ask her to pay your co-pay for you? 

SLS: No. But she refused to write for the individual prescriptions. 

CP: Hmm. I would tell her you'd be happy to take it however she wants as long as she is going to pay for it. Exactly how is this beneficial to you, the patient? 

SLS: It's not. And it's the only thing that's helped my arthritis. 

CP: Your prescriber would rather you take absolutely nothing and suffer than prescribe the medications separately? 

SLS: That's what she said. 

CP: Time to find a new practitioner.

Boss Conversation #3

CP's Partner: You down with CPP?
CP: Yeah, you know me. What's today's topic?
CPP: Corporate incongruity.
CP: Sounds exciting.
CPP: You need to do a piece on how out of touch corporate people are with reality.
CP: You mean more than the ones I do every day?
CPP: Yes. This has more to do with the comics you showed me about how corporate bosses expect the same level of performance after they've cut all your help to the marrow. Rather than doing what hasn't worked, let's try something else.
CP: Sounds good. Shall we begin?
CPP: Let us...I'll be DM.

DM: We have noticed that prescriptions are falling and customer service scores have dropped as well. The most common reason given is that wait times have increased.
CP: This makes sense. You cut our budget right before Pharmacy Winter and again after January 1st. Good timing.
DM: As a result, we are going to cut your budgeted hours. You will lose your pharmacist overlap on Mondays and your drive-thru tech help.
CP: Makes sense.
DM: I'm glad you agree.
CP: I mean it makes sense if you are trying to piss off the rest of the people who haven't complained yet.
DM: Come again?
CP: I'll try to use little words so you can follow. Maybe a few puppets and colourful illustrations for you. <waggles fingers>
DM: Pretty.
CP: Stay with me. We got busy during Pharmacy Winter with increased goals of flu shots, MTMs, other vaccines, and the usual winter sicknesses. We had insurance changes at the beginning of the year. During this time, you cut our hours. As a result of having fewer people to fill prescriptions, wait times increased. As a result of increased wait times, people complained about the wait times. People left us to go elsewhere. As a result of people leaving due to increased wait times, you see fit to slash our budget again. This will result in longer wait times. This will result in people leaving. This will, by your logic, result in more budget cuts. Do I understand you?
DM: Makes sense so far.
CP: No. In no world does this make sense. Let me ask you the follow up question. If your strategy works, and I am the only employee left in the pharmacy and business magically grows, will I get my hours back?
DM: No. I will observe that you are fully capable of handling it all yourself, tell you what a great job you are doing, remind you to make your quotas, and see you at evaluation time.
CP: When I will get no bonus.
DM: Correct. I will get it because I look awesome for slashing my budget.

CP: I have a proposal.
DM: Go ahead.
CP: Let's cut the number of DMs in half. You will now have double the territory. You will now be responsible for visiting all your stores twice a quarter instead of once. You will have the same budget as you did with half as many stores. You also must visit each store once as they are providing an inservice clinic or MTM. You may only fill up your gas tank once a week, on Wednesdays. If you do not make it to all your stores, we will cut your gas rations and expand your territory.

Boss Conversation #2

Arguing with a boss who doesn't understand your job is like arguing with rappers about the roundness of the Earth.

DM: What do you mean you are so far behind today? 

CP: As you can see on my computer, I have 80 prescriptions in the queue to be processed. 

DM: Okay. That's two hours of work. It's only noon. What't the problem? You'll be cleaned up by 2pm since you can fill 40 prescriptions an hour. 

CP: You're serious, aren't you? 

DM: Yes. I don't see the need for more help. In fact, I'm thinking about reducing your help. 

CP: Can we go back to "you'll be caught up in 2 hours" for a minute? 

DM: Sure. This is easy. What's the problem? 

CP: You never really spent any time in a pharmacy before becoming a DM, did you? 

DM: Duh. Yeah, like one year. It was easy. 

CP: They served you a special kind of Kool-Aid there, didn't they? 

DM: What? 

CP: Nothing. Let us take your rationale. IF we only had to fill those 80 prescriptions, you are saying I could get caught up in 2 hours, correct? 

DM: Yes. 

CP: How do you account for the rest of my day? The part where time doesn't stop?

DM: You get to zero and restart. 

CP: Piper was the Charmed One that could freeze time, not you. You are only looking at the 80 I have in my queue, yes? 

DM: Yes. 

CP: That would be fine IF my phone never rang, patients stopped bringing in new prescriptions, prescribers stopped sending electronic prescriptions, faxes stopped arriving, insurances did not need fixed, shots did not need to be given, MTMs did not need to be performed, breaks did not need to be taken, we didn't have to close for lunch, and the elves stopped pissing in my coffee pot. How do you account for all of the work that continues to come in while we are trying to fill your per hour quota? 

DM: The system works. 

CP: Have you ever seen pictures of the Earth?

FOR Babies

It's all about how you ask. For example:

Mom Lady: Do you have Baby Suppositories? 

CP: Heavens No! It's illegal to make suppositories out of babies. 

Of course I knew what ML was asking, but it's still phunny. She wanted to know where to find the suppositories FOR her baby. Which led to this question: 

CP: What are you looking to treat? 

ML: My baby. They go in her butt. 

Okay. I asked the question I wanted answered and she missed it completely. I also know how suppositories are used, butt...

CP: Fever or Constipation? 

ML: She can't poop. 

CP: Got it. You want glycerin suppositories. 

ML: They make ones for fever too? 

CP: Yes. Butt be sure you ask for the Fever Rectal Rockets next time if she needs those. 

Traveling

Quote of the Week: (btw, I am not in Hawaii)

Island Traveler: I just got to  Hawaii.
CP: Jolly good! Do have a delightful time.
IT: I just realized I did not bring enough medication to last the duration of my trip.
CP: How long will you be there?
IT: Two whole weeks.
CP: That is dreadful.
IT: "Can you give me some?"
CP: Huh?
IT: "Can you give me some?"
CP: How do you propose I accomplish this? You can transfer your prescription from us to a pharmacy there, but it's rather complicated.
IT:"I just need a few. Can't you just give them to me?"
CP: Would you like me to push some medication through the phone? You really don't understand how this whole time-space-travel thing works, do you? You got on a plane and are now many hours away from me yet you expect me to somehow make medication materialize through the phone instantly.
IT: Yes.
CP: Okay. Ask the concierge if they have a 3-D printer. If they do, go sit in front of it.
IT: Really?
CP: Yep. It takes a while but hey, you're on vacation in Hawaii!

Boss Conversation #1

The next time I am due for a review with my DM, I am going to let her know exactly how my day goes. They always ask for honesty, and the truth shall set you free. Maybe a little too free...

DM: How has the last year been for you?

CP: Exciting. Lots of new revelations and understandings have I now. 

DM: Such as? 

CP: I don't give two shits at work. 

DM: What? How is that professional? 

CP: I also started drinking after work. Have been for the last year now.
DM: That's not professional either. I think you need to talk with HR.

HR: Madam DM tells me you have some serious issues at work and we are concerned about your professionalism.
CP: Madam DM likes to lie a lot and make herself look good.
HR: I don't believe you. She is well respected.
CP: That's because she has you fooled.
HR: She said, and I quote, "CP said 'I don't two shits at work'."
CP: She's right. I'm not allowed to leave the pharmacy to use the bathroom. We are too busy and we are trying to improve customer satisfaction scores. Since she values the scores over my health and needs, I cannot make my way out of the pharmacy to poop. Therefore, I don't give two shits at work...they wait until I get home. She really needs to ask the appropriate follow up questions. Are you sure she is qualified to be a DM?
HR: There's another issue here we need to discuss. 

CP: I bet she told you I drink too?
HR: Yes.
CP: Again, I told her I started drinking after work.
HR: Alcoholism is a deadly disease.
CP: It is. Glad I'm not an alcoholic.
HR: But you said...
CP: I said "I started drinking after work". I did not say I am a spirited imbiber. We are not allowed to bring beverages with us into the pharmacy. Since we do not receive breaks of any kind, again valuing customer service over our own health, we cannot replenish our fluid levels. It makes it really easy to not pee during a day. Therefore, in order to get in all of my necessary liquids, I have to drink my water and tea when I arrive at home.
HR: She said you have a drinking problem.
DM: My DM really needs to get out a bit more and understand what it's like to be a pharmacist. Too bad she was promoted after one year out of school. She also needs to dig a little deeper to find out what Cynical Pharmacists mean when they talk.
HR: So you're saying she's a bad DM?
CP: Good follow up question. This is why you're in HR. You'd never make it as a DM.